Washington’s mental-health policies are killing people

Originally published October 28, 2009 at 4:22 pm
Updated October 28, 2009 at 6:31 pm

Washington state policy under the Involuntary Treatment Act is leaving too many people with mental illness to fend for themselves, writes guest columnist Mike Johnson. In extreme cases, people are dying, whether they kill themselves, or can't help themselves or harm others.

RECENTLY, Joseph tried to jump out of a window on the fourth floor of the Men’s Shelter of the Union Gospel Mission in Pioneer Square.

A fellow resident in our addiction-recovery program pulled him back in, and we took Joseph up the hill to the Psychiatric Emergency Room at Harborview Hospital … again. A few months earlier, police stopped Joseph from jumping from an overpass. Despite this history, Harborview informed us they were releasing Joseph after only a couple of hours in care … again. They couldn’t hold him, they argued.

As the director of the Mission’s Pioneer Square facility, I work every day with precious people struggling with addiction and mental illness. Last week, I stood under the Alaskan Way Viaduct with a homeless man who could not speak, and could move only with great difficulty. Rats circulated unafraid among his bags as my heart broke for him. This case is extreme, but real.

My considered opinion is that Washington state mental-health policy is killing people. It may kill Joseph. It will certainly kill that old man under the viaduct. It killed Shannon Harps in 2008, the Capitol Hill stabbing victim of James Anthony Williams, who stayed at our shelter at one point. Williams had been involuntarily committed after shooting at people waiting for a bus, but was later released under supervision.

Our state’s Involuntary Treatment Act (ITA) specifies that a person can be required to receive treatment if they present an “imminent” threat of harm to themselves or others, or if that person is “gravely disabled.” These words get defined by policies: What does “gravely disabled” actually mean at involuntary-commitment proceedings? In general, it means “one foot in a grave.”

Thus Joseph couldn’t even get care on the night he tried to jump out of our building, because that moment had passed and he was no longer an “imminent” threat — he’s not on the window ledge any more. And the viaduct man can’t get care because he’s not so disabled as to be on the verge of death.

Washington state policy must find a middle ground between the 1950’s overreadiness to lock people up, and the overreaction of the late 1970s deinstitutionalization that closed down whole systems. Surely we can respect freedom and still help people literally unable to help themselves. We must refund inpatient beds and reopen care wards closed down, and then we must actually be willing to put people into them.

Our policy claims to protect civil rights, but my job lets me see a consistent side effect: to turn real people struggling with mental illness onto the streets where some will simply die, and others will — from time to time — kill. Again, these are extreme cases, but real.

King County has a dedicated funding stream to address mental illness and drug dependency, and some good people working toward improving our systems. But without a willingness to commit people to care, and without an inpatient bed anyway, will things really change? Don’t go out on a ledge to wait.

Mike Johnson is the director of the Men’s Shelter of Seattle’s Union Gospel Mission in Pioneer Square.